Healthcare Provider Details

I. General information

NPI: 1003524802
Provider Name (Legal Business Name): CASEY MARRIE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2731 W OLIVE AVE
FRESNO CA
93728-2449
US

IV. Provider business mailing address

2731 W OLIVE AVE
FRESNO CA
93728-2449
US

V. Phone/Fax

Practice location:
  • Phone: 559-233-5096
  • Fax:
Mailing address:
  • Phone: 559-233-5096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberD6934884
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1500520323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: